Question 1

In the fee-for-service payment methodology, the prices are predetermined before delivery of service.

Accepted Answer

A) True 
 B)False  False

Question 2

Which of the following statements is true about the BCBS (Blue Cross Blue Shield) Association

Accepted Answer

A)  It is the single largest trade association of private health care insurers in the United States. 
B)  It covers hospital and related services only. 
C)  It covers physician services only. 
D)  It is a for-profit organization. 
A)  It is the single largest trade association of private health care insurers in the United States. 
B)  It covers hospital and related services only. 
C)  It covers physician services only. 
D)  It is a for-profit organization. A

Question 3

Match the managed care term with its descriptor.
-provides coordinated health care services by concentrating on vertical integration

Accepted Answer

A) HMO 
B) closed-panel arrangement 
C) PPO 
D) EPO 
E) POS
F)IDA 
A) HMO 
B) closed-panel arrangement 
C) PPO 
D) EPO 
E) POS
F)IDA F

Question 4

Medicare Part C covers prescription drugs.

Accepted Answer

A) True 
 B)False

Question 5

Despite severe criticism of capitation, the practice has continued to grow.

Accepted Answer

A) True 
 B)False

Question 6

Match the type of health care reimbursement program with its descriptor.
-provides health services to native American Indians & native Alaskans

Accepted Answer

A) Medicare Part A 
B) Medicare Part B 
C) Medicare Part C 
D) Medicare Part D 
E) Medicaid
F)TRICARE
G)CHAMPVA
H)worker's compensation
I)IHS 
A) Medicare Part A 
B) Medicare Part B 
C) Medicare Part C 
D) Medicare Part D 
E) Medicaid
F)TRICARE
G)CHAMPVA
H)worker's compensation
I)IHS

Question 7

Which of the following would be considered a third-party payer?

Accepted Answer

A)  The patient 
B)  The provider or institution providing care 
C)  The organization paying for the care 
D)  The laboratory services 
A)  The patient 
B)  The provider or institution providing care 
C)  The organization paying for the care 
D)  The laboratory services

Question 8

Match the type of health care reimbursement program with its descriptor.
-covers inpatient hospital care and long-term care for those over 65 years of age

Accepted Answer

A) Medicare Part A 
B) Medicare Part B 
C) Medicare Part C 
D) Medicare Part D 
E) Medicaid
F)TRICARE
G)CHAMPVA
H)worker's compensation
I)IHS 
A) Medicare Part A 
B) Medicare Part B 
C) Medicare Part C 
D) Medicare Part D 
E) Medicaid
F)TRICARE
G)CHAMPVA
H)worker's compensation
I)IHS

Question 9

All managed care plans have primary care providers.

Accepted Answer

A) True 
 B)False

Question 10

Match the type of health care reimbursement program with its descriptor.
-covers active-duty members of the armed services

Accepted Answer

A) Medicare Part A 
B) Medicare Part B 
C) Medicare Part C 
D) Medicare Part D 
E) Medicaid
F)TRICARE
G)CHAMPVA
H)worker's compensation
I)IHS 
A) Medicare Part A 
B) Medicare Part B 
C) Medicare Part C 
D) Medicare Part D 
E) Medicaid
F)TRICARE
G)CHAMPVA
H)worker's compensation
I)IHS

Question 11

TRICARE is for active duty members of the uniformed services.

Accepted Answer

A) True 
 B)False

Question 12

Three accrediting bodies address managed care organizations EXCEPT

Accepted Answer

A)  NCQA. 
B)  HEDIS. 
C)  JC. 
D)  AAAHC. 
A)  NCQA. 
B)  HEDIS. 
C)  JC. 
D)  AAAHC.

Question 13

The efficient management of reimbursement systems is critical if the organization's mission and financial goals are to be met.

Accepted Answer

A) True 
 B)False

Question 14

Explain medical necessity.

Accepted Answer

Medical necessity refers to the principl

Question 15

When a health care facility was required to justify to a state agency the need to purchase new equipment, buy or create new buildings, or offer new services, it was called

Accepted Answer

A)  cost allocation 
B)  certificate of need program 
C)  expansion request report 
A)  cost allocation 
B)  certificate of need program 
C)  expansion request report

Question 16

Match the managed care term with its descriptor.
-physicians employed by an HMO can only treat those patients who are members of the HMO plans

Accepted Answer

A) HMO 
B) closed-panel arrangement 
C) PPO 
D) EPO 
E) POS
F)IDA 
A) HMO 
B) closed-panel arrangement 
C) PPO 
D) EPO 
E) POS
F)IDA

Question 17

Match the managed care term with its descriptor.
-allows patients to choose the type of provider they will receive care from at or near the point of time the care will be received

Accepted Answer

A) HMO 
B) closed-panel arrangement 
C) PPO 
D) EPO 
E) POS
F)IDA 
A) HMO 
B) closed-panel arrangement 
C) PPO 
D) EPO 
E) POS
F)IDA

Question 18

Describe a certificate of need program?

Accepted Answer

A certificate of need program requires h

Question 19

Part _____ of Medicare helps pay for physician and outpatient charges.

Accepted Answer

A)  A 
B)  B 
C)  C 
D)  D 
A)  A 
B)  B 
C)  C 
D)  D

Question 20

The ______________________ ______________________ ______________________ is the physician who serves as the gatekeeper or coordinator for all the patient's care.

Accepted Answer

primary ca

In the fee-for-service payment methodology, the prices are predetermined before delivery of service.

Which of the following statements is true about the BCBS (Blue Cross Blue Shield) Association

Match the managed care term with its descriptor. -provides coordinated health care services by concentrating on vertical integration

Medicare Part C covers prescription drugs.

Despite severe criticism of capitation, the practice has continued to grow.

Match the type of health care reimbursement program with its descriptor. -provides health services to native American Indians & native Alaskans

Which of the following would be considered a third-party payer?

Match the type of health care reimbursement program with its descriptor. -covers inpatient hospital care and long-term care for those over 65 years of age

All managed care plans have primary care providers.

Match the type of health care reimbursement program with its descriptor. -covers active-duty members of the armed services

TRICARE is for active duty members of the uniformed services.

Three accrediting bodies address managed care organizations EXCEPT

The efficient management of reimbursement systems is critical if the organization's mission and financial goals are to be met.

Explain medical necessity.

When a health care facility was required to justify to a state agency the need to purchase new equipment, buy or create new buildings, or offer new services, it was called

Match the managed care term with its descriptor. -physicians employed by an HMO can only treat those patients who are members of the HMO plans

Match the managed care term with its descriptor. -allows patients to choose the type of provider they will receive care from at or near the point of time the care will be received

Describe a certificate of need program?

Part _____ of Medicare helps pay for physician and outpatient charges.

The __ is the physician who serves as the gatekeeper or coordinator for all the patient's care.

Health Care Delivery Systems

The Health Information Management Profession

Legal Issues

Ethical Standards

Health Data Content and Structures

Nomenclatures and Classification Systems

Quality Health Care Management

Health Statistics

Research

Database Management

Information Systems Technology

Informatics

Management Organization

Human Resource Management

Financial Management

Filters

Exam 16: Reimbursement Methodologies

In the fee-for-service payment methodology, the prices are predetermined before delivery of service.

Which of the following statements is true about the BCBS (Blue Cross Blue Shield) Association

Match the managed care term with its descriptor. -provides coordinated health care services by concentrating on vertical integration

Medicare Part C covers prescription drugs.

Despite severe criticism of capitation, the practice has continued to grow.

Match the type of health care reimbursement program with its descriptor. -provides health services to native American Indians & native Alaskans

Which of the following would be considered a third-party payer?

Match the type of health care reimbursement program with its descriptor. -covers inpatient hospital care and long-term care for those over 65 years of age

All managed care plans have primary care providers.

Match the type of health care reimbursement program with its descriptor. -covers active-duty members of the armed services

TRICARE is for active duty members of the uniformed services.

Three accrediting bodies address managed care organizations EXCEPT

The efficient management of reimbursement systems is critical if the organization's mission and financial goals are to be met.

Explain medical necessity.

When a health care facility was required to justify to a state agency the need to purchase new equipment, buy or create new buildings, or offer new services, it was called

Match the managed care term with its descriptor. -physicians employed by an HMO can only treat those patients who are members of the HMO plans

Match the managed care term with its descriptor. -allows patients to choose the type of provider they will receive care from at or near the point of time the care will be received

Describe a certificate of need program?

Part _____ of Medicare helps pay for physician and outpatient charges.

The ______________________ ______________________ ______________________ is the physician who serves as the gatekeeper or coordinator for all the patient's care.

Health Care Delivery Systems

The Health Information Management Profession

Legal Issues

Ethical Standards

Health Data Content and Structures

Nomenclatures and Classification Systems

Quality Health Care Management

Health Statistics

Research

Database Management

Information Systems Technology

Informatics

Management Organization

Human Resource Management

Financial Management

Filters

The __ is the physician who serves as the gatekeeper or coordinator for all the patient's care.